Clinical Ophthalmology (Feb 2023)
Real-World Experience Using Intravitreal Brolucizumab Alone or in Combination with Aflibercept in the Management of Neovascular Age-Related Macular Degeneration
Abstract
Neesurg Mehta,1 Rodney D Fong,1,2 Machelle Wilson,3 Kareem Moussa,1 Parisa Emami-Naeini,1,4 Ala Moshiri,1 Glenn Yiu,1 Susanna S Park1 1Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA; 2University of Nevada, Reno School of Medicine, Reno, NV, USA; 3Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, CA, USA; 4Department of Ophthalmology, Veterans Administration Hospital, Mather, CA, USACorrespondence: Susanna S Park, Department of Ophthalmology & Vision Science, University of California Davis Health, Ernest E. Tschannen Eye Institute, 4860 Y St, Sacramento, CA, 95817, USA, Tel +1 916 734 6074, Fax +1 916 703 5076, Email [email protected]: To evaluate real-world experience using intravitreal brolucizumab (IVBr), alone or in combination with aflibercept, in eyes with neovascular age-related macular degeneration (nAMD) treated previously with other inhibitors of VEGF (anti-VEGF).Methods: This was a retrospective study of all eyes with nAMD treated with IVBr on a treat-and-extend protocol at a single center. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) at baseline and final visit, and drug-related adverse events were analyzed. Eyes with recurrent macular fluid on IVBr every 8 weeks were treated with a combination therapy alternating between IVBr and aflibercept every month.Results: Among 52 eyes (40 patients) on IVBr, all had been previously treated with other anti-VEGF therapy, with 73% having persistent macular fluid. After a mean follow-up of 46.2± 27.4 weeks on IVBr, the mean treatment interval for intravitreal therapy increased to 8.8± 2.1 weeks on IVBr from a baseline of 6.1± 3.1 weeks (p< 0.001). Macular fluid decreased and BCVA was stable/improved in 61.5% of eyes on IVBr. Ten eyes with increased macular fluid on IVBr monotherapy when extended to every 8 weeks were treated with combination therapy alternating between IVBr and aflibercept every 4 weeks. In these eyes, 80% had improved macular fluid on OCT and 70% stable or improved BCVA after a median follow-up of 53 weeks on combination therapy. Mild intraocular inflammation developed in four eyes, all occurring on IVBr monotherapy, and none had associated vision loss.Conclusion: In the real world, IVBr used to treat eyes with nAMD previously treated with other anti-VEGF therapies appears to be well tolerated and associated with an improvement in macular fluid, stabilization of BCVA, and/or increase in intravitreal treatment interval. Combination therapy alternating between IVBr and aflibercept monthly appears to be well tolerated and can be considered for eyes with macular fluid on IVBr every 8 weeks.Keywords: age-related macular degeneration, aflibercept, anti-VEGF, brolucizumab, intravitreal injection; optical coherence tomography
